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The health of the majority of South Africa’s population is seriously threatened by hunger and micronutrient deficiency, with impaired immune response a real threat, which the current SARSCoV-2 virus pandemic has highlighted. Traditional household food-processing techniques can, amongst other advantages, increase nutrient bioavailability in affordable staple foods and hence provide a way, in part, to alleviate malnutrition for food-insecure communities. In this way, immune defence and pathogen resilience of the food insecure could be enhanced so that they can better survive both COVID-19 and future threats. [ABSTRACT FROM AUTHOR] Copyright of South African Journal of Clinical Nutrition is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Children with thalassemia major (TM) are prone to growth failure and micronutrient deficiency. Thus, this study aimed to evaluate nutritional status, anthropometrics, and bone mineralization defects in patients with regular blood transfusion.Data obtained were analyzed by evaluating laboratory tests, anthropometric measures, and bone mineral density.This study included 29 patients (62% male and 38% female) with a mean age of 12.26±4.74 years, mean pre-transfusion hemoglobin of 8.64±1.01 g/dL, and mean serum ferritin of 1158.6±556.8 ng/ mL. Vitamin D (72.4%), selenium (72.4%), and folate (37.9%) deficiencies were most frequent. Hypocalcemia was observed in 17.2%, hypomagnesemia in 3.5%, and decreased ceruloplasmin in 10.3% of patients. Folate was higher between 2 and 6 years old (p=0.028). Ceruloplasmin was higher between 6 and 10 years old (p=0.018). Selenium was significantly higher in patients with a ferritin of ≥1,500 (p=0.008). No significant ferritin-related differences were found in other micronutrients (p0.05). Body mass index (BMI) were5 percentile (p) in 31% of patient, whereas none was95 p. Height in 24.5% and weight in 20.7% of patients were3 p, whereas none with97 p. BMI of patients aged 10-18 years was significantly higher (p=0.001). Anthropometric percentiles did not significantly differ in the mean serum ferritin and micronutrient levels. Hypoparathyroidism was observed in 13.8% and hypothyroidism in 3.5% of patients. Low bone density was detected in 14.8% (2 osteopenic and 2 osteoporotic) of patients. Bone mineral density did not significantly differ in the ferritin and micronutrient levels.Nutritional support and deficiency prevention are important to minimize the burden of complications and increase the life expectancy and quality in patients with TM.Talasemi majör (TM) tanılı çocuklar büyüme geriliğine ve mikrobesin eksikliklerine yatkındırlar. Bu çalışmada, düzenli transfüzyon uygulanan hastalarda mikro besin seviyelerini, antropometrik ölçümleri, kemik mineralizasyon defektlerini değerlendirmeyi amaçladık.Laboratuvar testlerini, antropometrik ölçümleri ve kemik mineral yoğunluğunu değerlendirerek elde edilen verileri analiz ettik.Çalışmaya ortalama yaşı 12,26±4,74 yıl, ortalama transfüzyon öncesi hemoglobin 8,64±1,01 g/dL, ortalama serum ferritin 1158,6±556,8 ng/mL olan 29 hasta (%62’si erkek, %38’i kız) alındı. En sık vitamin D (%72,4), selenyum (%72,4) ve folat (%37,9) eksikliği saptandı. Hastaların %17,2’de hipokalsemia, %3,5 hipomagnesemi, %10,3 seruloplazmin düşüklüğü saptandı. Folat 2≤ ile6 yaş arasında, seruloplazmin 6≤ ile10 yaş arasında daha yüksek saptandı (sırasıyla p=0,028, p=0,018). Selenyum, ferritin ≥1.500 olan hastalarda anlamlı olarak yüksekti (p=0,008). Diğer mikrobesin düzeylerinde ferritin düzeyi ilişkili anlamlı farklılık saptanmadı (p0,05). Hastaların %31’inin vücut kitle indeksi (VKİ) 5. Persentilin (p) altındaydı. VKİ 95. p’nin üzerinde olan hasta saptanmadı. Hastaların %24,5’inin boyu, %20,7’sinin vücut ağırlığı 3. p’nin altındaydı. Boy ve vücut ağırlığı açısından 97. p’nin üzerinde olan hasta saptanmadı. Antropometrik ölçümlerin, hastaların kan mikrobesin ve ferritin düzeyleri ile anlamlı bir ilişkisi saptanmadı. On-18 yaş arasındaki hastaların VKİ anlamlı olarak daha yüksek bulundu (p=0,001). Antropometrik ölçümler, ortalama ferritin ve mikrobesin düzeyleri açısından anlamlı farklılık göstermedi. Hastaların %20,8’de endokrinolojik bozukluklar (hipoparatiroidi %13,8, hipotiroidi %3,5) gözlendi. Hastaların %14,8’inde (2 osteopenik, 2 osteoporotik) düşük kemik yoğunluğu saptandı. Kemik mineral yoğunluğunun mikrobesin ve ferritin düzeyleriyle anlamlı ilişkisi saptanmadı.TM hastalarında nütrisyonel eksikliklerin önlenmesi ve beslenme desteğinin sağlanması kemik mineralizasyon bozuklukları ve büyüme geriliği gibi komplikasyonların gelişiminin en aza indirilmesi açısından önemlidir.

В статье рассмотрены вопросы существования микронутриентных дефицитных состояний в Украине, влияющих на эффективность работы щитовидной железы и развитие тиреоидной патологии. Представлен клинический опыт использования фиксированной комбинации микроэлементов йода и селена в физиологических дозах в профилактике таких нарушений. Доказана возможность влияния данной комбинации на стабилизацию имеющейся тиреоидной патологии и безопасность применения при аутоиммунных заболеваниях.

Malnutrition causes diseases, immune system disorders, deterioration in physical growth, mental development, and learning capacity worldwide. Micronutrient deficiency, known as hidden hunger, is a serious global problem. Biofortification is a cost-effective and sustainable agricultural strategy for increasing the concentrations or bioavailability of essential elements in the edible parts of plants, minimizing the risks of toxic metals, and thus reducing malnutrition. It has the advantage of delivering micronutrient-dense food crops to a large part of the global population, especially poor populations. Agronomic biofortification and biofertilization, traditional plant breeding, and optimized fertilizer applications are more globally accepted methods today; however, genetic biofortification based on genetic engineering such as increasing or manipulating (such as CRISPR-Cas9) the expression of genes that affect the regulation of metal homeostasis and carrier proteins that serve to increase the micronutrient content for higher nutrient concentration and greater productivity or that affect bioavailability is also seen as a promising high-potential strategy in solving this micronutrient deficiency problem. Data that micronutrients can help strengthen the immune system against the COVID-19 pandemic and other diseases has highlighted the importance of tackling micronutrient deficiencies. In this study, biofortification approaches such as plant breeding, agronomic techniques, microbial fertilization, and some genetic and nanotechnological methods used in the fight against micronutrient deficiency worldwide were compiled.

BackgroundIn the tribal state of Jharkhand, there have been very few studies on micronutrient deficiency and how it is addressed among school children. This study was conceived and undertaken to assess the effect of milk supplementation on the micronutrient status of school children.DesignA comparative observational study was conducted among school children of a tribal district in India during 2017–2018. Two groups of schools/clusters were randomly selected, one with milk supplementation and the other without supplementation. A total of 318 children from the two groups of schools were recruited for biochemical analysis of certain micronutrients, such as calcium, vitamin D, vitamin B12 and iron (haemoglobin level), using cluster random sampling. Data were analysed using SPSS V.20.0 software, and multiple logistic regression analysis was done to determine the predictors of serum calcium and vitamin B12 level among school children.ResultsAlmost all children from both groups had vitamin D deficiency. A higher risk of lower serum vitamin B12 level (OR 2.59, 95% CI 1.61 to 4.16) and calcium level (OR 3.36, 95% CI 1.74 to 6.49) was observed in children of the control group. The difference in the proportion of anaemia in the two study groups was found to be statistically insignificant. Milk consumption was found to be the only significant predictor of normal vitamin B12 and calcium level in the present study.ConclusionsIn this study, it was concluded that milk consumption may help in improving the calcium and vitamin B12 status of school children of a tribal state, whereas it does not have any significant effect on vitamin D level.

Background: Iron deficiency anemia (IDA) is the most prevalent micronutrient deficiency in preschool children in developing countries including India. IDA is associated with immune perturbation, which is reflected in greater frequency of infections in these children. Recent research has shown three distinct monocyte subsets with distinct functions linked to infectious, inflammatory, and autoimmune diseases. These subsets have not been studied in chil-dren with IDA. Objective: The aim of the study was to assess the percentage of monocyte population and the three subset populations in children with IDA and to compare the data with age-matched healthy controls. Methods: Venous blood samples (5 mL) from 40 IDA children and 20 controls were collected after taking informed consent. Monocyte subpopulations were compared across the two groups. The outcome variables were calculated using Students Independent t-test or Mann– Whitney U test. P value of

The Indonesian Government’s targets to reduce the prevalence of child malnutrition are unlikely to be met based on current progress. Adequate dietary intake is key to meeting these targets. This systematic review aimed to provide a comprehensive overview of the nutrient and food intake of Indonesian children under five years of age. Peer-reviewed and gray literature published between 2007 and 2019 were collected. Of 1500 records, 38 articles met the study inclusion criteria and a narrative analysis was conducted. Children under five years were reported to have ranging energy and macronutrient intakes, some with adequate protein intake. Micronutrient deficiencies, particularly iron, zinc, calcium, and vitamin C, were reported. Animal-source foods, fruits, and vegetables were consumed by children, but frequency and/or volume of consumption was low, and it is among the probable causes of micronutrient deficiency among children under five years. The absence of reporting micronutrient intake in the national survey limited evidence to inform nutrition-related policies. The implementation of a national micronutrient survey will be beneficial in informing policy and practice aimed at reducing the prevalence of child malnutrition in line with national targets, through improvement in dietary intake.

Both excessive daytime sleepiness (EDS) and nutritional deficiencies are common and can cause similar negative consequences, such as falls, and cognitive impairment in older adults, but there is no study investigating the relationship between the two. The aim of this study is to investigate the relationship between malnutrition/micronutrient deficiency and EDS in patients with and without dementia.Cross-sectional study.A total of 800 outpatients (243 of whom had dementia), aged ≥65 years, were included.All patients underwent comprehensive geriatric assessment. Mini Nutritional Assessment (MNA) scores23.5, 17-23.5, or17 were categorized as well-nourished, malnutrition risk, and malnutrition, respectively. Eating Assessment Tool score of ≥3 was accepted as dysphagia. Serum vitamin BThe mean age was 79.1±7.5 years. The prevalence of EDS was 22.75%. In patients with dementia, those with EDS had significantly lower MNA scores and more frequent dysphagia (P.05). In patients without dementia, those with EDS have lower MNA scores than those without EDS; malnutrition, dysphagia, and vitamin D deficiency were higher (P.05). In multivariable analysis adjusted for age, gender, living status, ischemic heart disease, cerebrovascular events, polypharmacy, dementia, and insomnia, the association between EDS and malnutrition [odds ratio (OR) 1.73, 95% confidence interval (CI) 1.37-2.20], dysphagia (OR 2.01, 95% CI 1.33-2.88), and vitamin D deficiency (OR 2.0, 95% CI 1.12-3.55) persisted.There is a significant relationship between EDS and malnutrition risk, dysphagia, and vitamin D deficiency in older adults. Therefore, when examining an older patient with EDS, dysphagia, malnutrition, and vitamin D levels should be evaluated, or EDS should be investigated in an older patient with malnutrition, dysphagia, and vitamin D deficiency. Thus, it will be possible to manage all these conditions more effectively.

The purpose of the review is to analyze the results of the use of vitamin-mineral supplements (MMS) during pregnancy using the databases of the RSCI, CyberLeninka, pubMed. The detection of micronutrient deficiency in a significant part of pregnant women requires its unconditional correction by taking vitamin-mineral supplements. In recent years, the emphasis has shifted to studying the effect of MMS intake on the course and outcomes of pregnancy. The effects described in the literature should be treated critically. Most of the studies are based only on a retrospective survey of pregnant women (according to the ‘yes' or ‘no' principle), their supply of micronutrients is not monitored; no causal relationship is established. There is no objective monitoring of the MMS intake. Uncertainties include the composition and doses of micronutrients in the MMS used, the lack of data on drug intake, the assumption that all MMS are equivalent in composition and micronutrient content, and the grouping of women taking MMS with different composition into one group. In addition, the use of incorrect indicators in assessing the physical growth of children occurs. The positive effect of additional intake of MMS is manifested only if initially there was a deficiency of micronutrients.Conclusions. The intake of MMS during pregnancy improves the supply of vitamins for those women in whose diet there is a lack of them. This prophylaxis reduces the risk of adverse pregnancy outcomes due to vitamin deficiencies.

Micronutrient deficiency in the diet of a pregnant woman can negatively affect not only the course and outcome of childbirth, but lead to long-term changes in the metabolism, structure and function of fetal organs. The results of numerous studies confirm the influence of nutrition on adaptation reserves, the ability to learn and the predisposition to the development of diseases in offspring. Fetal programming can influence the course of ontogenesis, the processes of development, maturation and aging of the body. The nature of intrauterine nutrition affects the health and the risk of subsequent diseases not only in children, but also in adults in the long term. For the prevention of unfavorable fetal programming, timely examination of pregnant women is necessary to detect the presence of nutritional disorders. To correct micronutrient deficiency in pregnant women, an integrated approach is used, including diet therapy using appropriate vitamin and mineral complexes. in the prevention and complex therapy of somatic diseases.

Background. It is known that malnutrition significantly affects human life expectancy and leads to the emergence and development of non-communicable diseases. A balanced diet is a leading factor in the prevention of gastrointestinal diseases. The purpose was to investigate the state of actual nutrition, indicators of nutritional status and gastrointestinal morbidity in school-age children. Materials and methods. The study was conducted on the basis of secondary schools in Chernivtsi and MNPE “Chernivtsi Regional Children’s Clinical Hospital”. A questionnaire method was used with the compilation of individual menus and subsequent analysis of the chemical composition of diets in 162 students. Depending on the state of health, children were divided into groups: I (n = 90) — those with chronic gastrointestinal diseases, II (n = 44) — with functional gastrointestinal disorders, III (n = 28) — individuals without gastrointestinal pathology. Results. Chronic gastrointestinal pathology was diagnosed in 55.5 % of the exa­mined children, functional gastrointestinal diseases — in 27.2 %. The most common chronic pathology is chronic gastroduodenitis. The majority of the surveyed children did not follow the diet, namely 56.5 % of children violated the frequency of intake, 69.2 % did not adhere to the intervals between meals. Most of patients (59.2 %) eat 3–5 times a day, 29.1 % of them eat 3–4 times a day, 30.1 % eat 4–5 times, and 11.7 % less than three times a day. One third of children do not have breakfast at home, and 19.5 % do not have a second breakfast at school. The caloric value of daily diets is lower than the normative indicators, it averages 2,337.64 ± 65.16 kcal and is insufficiently provided by the main components: proteins by 12 %, fats by 25 % and carbohydrates by 63 %. Macro- and micronutrient deficiency is also registered in 53.1 % of children, especially of calcium, phosphorus, copper, zinc, and iodine. Children of groups II and III are less likely to eat fast food compared to those of group I (34.1 and 32.1 vs. 53.3 %, p < 0.05). Conclusions. The diet and nutrition of school-age children with gastrointestinal pathology does not meet hygienic requirements and not only does not provide primary prevention of non-communicable diseases, but, on the contrary, is a risk factor for the latter., Актуальність. Відомо, що нераціональне харчування суттєво впливає на тривалість життя людини та призводить до виникнення й розвитку неінфекційних захворювань. Саме раціональне харчування є провідним фактором у профілактиці захворювань шлунково-кишкового тракту (ШКТ). Мета: дослідити стан фактичного харчування, окремі показники харчового статусу та захворюваність шлунково-кишкового тракту в дітей шкільного віку. Матеріали та методи. Дослідження проводилося на базі середніх освітніх закладів м. Чернівці та КНП «Чернівецька обласна дитяча клінічна лікарня». Використано анкетно-опитувальний метод зі складанням індивідуальних меню-розкладок та подальшим аналізом хімічного складу раціонів харчування у 162 школярів. Залежно від стану здоров’я діти розподілені на групи: І (n = 90) — діти з хронічними захворюваннями ШКТ, ІІ (n = 44) — діти з функціональними розладами ШКТ, ІІІ (n = 28) — без патології ШКТ. Результати. У 55,5 % обстежених дітей діагностовано хронічну патологію ШКТ, у 27,2 % — функціональні захворювання ШКТ. Найбільш поширеною хронічною патологією визначено хронічні гастродуоденіти. Більшість обстежених дітей не дотримувалися режиму харчування, а саме в 56,5 % дітей порушена кратність прийому, у 69,2 % — недотримання інтервалів між прийомами їжі. Більша частина обстежених дітей (59,2 %) прий­мають їжу 3–5 разів на добу, із них по 3–4 рази на добу приймають їжу 29,1 % і по 4–5 разів — 30,1 % дітей, а менше трьох разів на добу харчуються 11,7 %. Третина дітей не снідає вдома, а 19,5 % не мають другого сніданку в школі. Енергетична цінність добових раціонів харчування нижча за нормативні показники, становить у середньому 2337,64 ± 65,16 ккал та недостатньо забезпечується за рахунок основних складових: білків — на 12 %, жирів — на 25 % та вуглеводів — на 63 %. У 53,1 % дітей виражено реєструється також макро- і мікроелементна недостатність, особливо це стосується вмісту кальцію, фосфору, міді, цинку, йоду. Діти ІI та ІІІ груп рідше вживають продукти харчування типу фаст-фуд порівняно з дітьми І групи (34,1 % та 32,1 % проти 53,3 %, р < 0,05). Висновки. Раціон та режим харчування дітей шкільного віку з патологією шлунково-кишкового тракту не відповідають гігієнічним вимогам і не тільки не забезпечують первинну профілактику неінфекційних захворювань, але і, навпаки, є ризик-факторами виникнення останніх.

Background Micronutrient deficiency is a known cause of adverse neurodevelopment and growth. Poor adherence to oral regimes of micronutrient supplements is a known challenge during the implementation of supplementation programs. The present study evaluates the benefits of liposomal encapsulated micronutrient fortified body oils (LMF oil) that can be used for infant body massage in terms of neurodevelopment and prevention of deficiency. Study design Double-blind randomized clinical trial. Methods A total of 444 healthy infants aged 4-7 weeks were randomized to receive either LMF oil (containing iron, vitamin D, folate, and vitamin B12) or placebo oil for gentle body massage till 12 months of age. Blood samples were collected at 6 and 12 months for transferrin saturation (TSAT), hemoglobin, and 25-hydroxy vitamin (25-OH-D) levels. Mental and motor development was assessed at 12 months using developmental assessment for Indian Infants (DASII). Results A total of 391 infants completed the study. There was no significant improvement in the hemoglobin in the intervention group at 12 months of age as compared to the placebo group [− 0.50 vs.-0.54 g%]. There was a marginally significant improvement in 25-OH-D at 12 months in the LMF oil group [+ 1.46vs.-0.18 ng/ml, p = 0.049]. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age [adjusted mean change + 0.11vs.-0.51 g%, p = 0.043]. The mental or motor developmental quotients in the intervention group were not significantly different from those in the placebo group. Conclusion Use of LMF oil for prevention of nutritional deficiency did not offer significant protection against nutritional anemia but prevented vitamin D deficiency to some extent with improvement in 25-OH-D at 12 months. In the subgroup of infants with moderate anemia, the intervention prevented the decline in hemoglobin at 12 months of age. The intervention did not result in significant improvement in mental or motor development. Further evaluation with increased doses needs to be undertaken. Trial registration CTRI no: CTRI/2017/11/010710; dated 30/11/2017.

The relationship between prepregnancy body mass index (BMI) and maternal micronutrient status is inconsistent and has not received sufficient attention. This meta-analysis aimed to evaluate the effect of prepregnancy BMI on micronutrient levels in pregnant women. PubMed, Embase, Web of Science, and the Cochrane Library were searched for articles that contained information on micronutrient levels and prepregnancy BMI. A random-effects model was used to determine the association between prepregnancy BMI and maternal micronutrient status. Sixty-one eligible articles were eventually included, with 83,554 participants. Vitamin B12, folate, vitamin D, iron and ferritin were the main micronutrients evaluated in our meta-analysis. Prepregnancy obesity and overweight may lead to an increased risk of micronutrient deficiency, including vitamin B12, folate and vitamin D deficiency, while prepregnancy obesity or overweight may have no significant association with ferritin deficiency. Additionally, the results of the dose–response analyses demonstrated a possible significant inverse correlation between prepregnancy BMI and levels of micronutrient, except for iron and ferritin. Compared with women with normal weight, women who were overweight or obese prepregnancy have lower micronutrient concentrations and are more likely to exhibit micronutrient deficiency during pregnancy, which is harmful to both mothers and neonates.

The purpose of this systematic review was to determine if in patients presenting for bariatric surgery, patients of different ethnicities, have different micronutrient deficiencies preoperatively. Databases searched were PubMed, Embase, MEDLINE and Cochrane Library. A meta-analysis of prevalence of vitamin D insufficiency (

The inadequacy of micronutrients, namely essential vitamins and minerals in the human diet, manifests a wide range of moderate to serious health concerns collectively known as micronutrient malnutrition. It affects half of the global population, and food-based strategies such as balanced diet, supplementation and food fortification are effective. The balanced diet and dietary supplementation are desirable and sustainable; however, their efficacy is uncertain due to the required demands to improve dietary habits. Interestingly, food fortification – addition of micronutrients to processed foods - supplies micronutrients without the need to alter eating habits and unquestionably stands out as a systematic approach to moderate the statistical rise in micronutrient malnutrition. On the other hand, biofortification - plant breeding and/or genetic engineering - is a convenient and sustainable strategy with myriad possibilities to augment micronutrients status that could endure through generations. These approaches coupled with meticulously organized innovative policies and a competent food value chain will indeed aid in addressing the micronutrient deficiency toward building a productive and efficient generation.

Background and objective: Exclusive breastfeeding is recommended for all newborns to gain optimal physical and neurodevelopmental growth. Despite all its advantages, prolonged breastfeeding alone without weaning places the child at risk of iron deficiency and iron deficiency anemia, which is the commonest micronutrient deficiency worldwide among infants. We investigated the effect of early weaning on the iron status of infants. Methods: We selected 100 infants; all of them were six months old. Fifty of them were exclusively breastfed for four months and started weaning between four to six months while continued to breastfeed till the age of six months (early-weaning group). Another 50 infants were exclusively breastfed for six months without starting weaning (no-weaning group). Then we investigated both groups at the age of six months for both iron and hematological studies. Results: In the present study, both study groups shared some similarities. In both groups, females accounted for more than half of the cases, the majority of the infants were residing in the urban areas, and most of the infants were delivered by cesarean section. The final result of the iron study and hematological parameters in the no-weaning group was significantly lower as compared to the early-weaning group. Both serum ferritin and serum iron were 7.42 ng/ml and 25.66 µg/dl, respectively, in the no-weaning group and were 23.94 ng/ml and 46.98 µg/dl respectively in the early-weaning group. Hemoglobin level was 10.84 gm/dl in the no-weaning group compared to 11.54 gm/dl in the early-weaning group. Conclusion: We concluded that early weaning had a great role in the prevention of both iron deficiency and iron deficiency anemia in exclusively breastfed infants. Keywords: Exclusive breastfeeding; Early weaning; Iron status.

Jason E Pope,1 Michael A Fishman,2 Joshua A Gunn,3 Bradley M Cotten,3 Melissa M Hill,3 Timothy R Deer4 1Evolve Restorative Center, Santa Rosa, CA, USA; 2Center for Interventional Pain and Spine, Lancaster, PA, USA; 3Ethos Research and Development, LLC, Newport, KY, USA; 4The Spine and Nerve Center of the Virginias, Charleston, WV, USACorrespondence: Jason E PopeEvolve Restorative Center, Santa Rosa, CA, USATel +1844 527-7369Email jepope@evolverestorativecenter.carePurpose: Discovery and validation of pragmatic biomarkers represent significant advancements in the field of pain management. Evaluating relationships between objective biomarkers and patient-reported outcomes (PROs) is an effective way to gain mechanistic insight into the potential role of biochemistry in chronic pain. The aim of this study was to validate the Foundation Pain Index (FPI) by evaluating associations between deranged biochemical function and PROMIS-29 domains in individuals living with chronic pain.Patients and Methods: PROMIS-29 scores and FPI test results were obtained from 298 patients with chronic pain in this retrospective, observational study. Statistical analysis was performed using clinical test data to evaluate relationships between deranged biochemical function and quality of life measures across 8 universal domains.Results: FPI scores significantly associated with multiple PROMIS-29 domains including physical function, impact score, fatigue, pain interference, and depression (P < 0.05). Moreover, specific analytes that comprise the FPI significantly correlated with PROMIS-29 domains, including 5-hydroxyindolacetic acid (pain interference, physical function, and pain impact scores), hydroxymethylglutarate (physical function), homocysteine (pain impact scores), kynurenic acid (pain interference and physical function), and quinolinic acid (physical function) (P < 0.05).Conclusion: Cross-validation of the FPI with PROMIS-29 domains further supports the role of deranged biochemical function in the etiology of chronic pain. Objective identification of atypical biochemical function and subsequent correction holds tremendous promise for the non-opioid management of pain. Continued research efforts will aim to determine the impact of biochemical optimization in pre-surgical periods and post-surgical outcomes in patients with chronic pain.Keywords: biomarker, pain, oxidative stress, neurotransmitter, micronutrient deficiency, kynurenine pathway

Vaccines are the most effective measure to prevent deaths and illness from infectious diseases. Nevertheless, the efficacy of several paediatric vaccines is lower in low-income and middle-income countries (LMICs), where mortality from vaccine-preventable infections remains high. Vaccine efficacy can also be decreased in adults in the context of some common comorbidities. Identifying and correcting the specific causes of impaired vaccine efficacy is of substantial value to global health. Iron deficiency is the most common micronutrient deficiency worldwide, affecting more than 2 billion people, and its prevalence in LMICs could increase as food security is threatened by the COVID-19 pandemic. In this Viewpoint, we highlight evidence showing that iron deficiency limits adaptive immunity and responses to vaccines, representing an under-appreciated additional disadvantage to iron deficient populations. We propose a framework for urgent detailed studies of iron-vaccine interactions to investigate and clarify the issue. This framework includes retrospective analysis of newly available datasets derived from trials of COVID-19 and other vaccines, and prospective testing of whether nutritional iron interventions, commonly used worldwide to combat anaemia, improve vaccine performance.

X-linked myotubular myopathy (XLMTM) is a rare congenital myopathy characterized by profound hypotonia and poor respiratory effort at birth. The condition is associated with multiple morbidities including chronic respiratory insufficiency, feeding tube dependence, and rarely, vitamin K deficiency leading to bleeding and coagulopathy. We report a case of a 6-month-old boy with X-linked myotubular myopathy who experienced a fatal intracranial hemorrhage due to vitamin K deficiency without prior clinical evidence of cholestasis or micronutrient deficiency. We propose clinically non-apparent cholestasis in combination with acute illness and poor weight gain led to his vitamin K deficiency and intracranial hemorrhage. However, the etiology and mechanism of his cholestasis remains unclear. We conclude that children with X-linked myotubular myopathy, especially with gene therapy on the horizon, may benefit from routine hepatic, coagulation, and nutritional screening to prevent potentially catastrophic bleeding.

Visual disturbance or visual failure due to toxicity of an ingested substance or a severe nutritional deficiency can present significant challenges for diagnosis and management, for instance, where an adverse reaction to a prescribed medicine is suspected. Objective assessment of visual function is important, particularly where structural changes in the retina or optic nerve have not yet occurred, as there may be a window of opportunity to mitigate or reverse visual loss. This paper reviews a number of clinical presentations where visual electrophysiological assessment has an important role in early diagnosis or management alongside clinical assessment and ocular imaging modalities. We highlight the importance of vitamin A deficiency as an easily detected marker for severe combined micronutrient deficiency.

Aims: Obstructive sleep apnoea (OSA) affects patients’ quality of life and health. Magnesium (Mg) is an essential mineral and a potent antioxidant. Mg deficiency can worsen oxidative stress caused by sleep deprivation or disorders. The impact of OSA on serum Mg levels and its health consequences remain unclear. Data Synthesis: This study systematically reviewed clinical studies investigating the serum Mg levels of OSA patients and the potential relationships with other biomarkers. Six articles were included for qualitative synthesis and quantitative analysis. Two out of four studies that compared OSA patients to healthy controls found them to have significantly lower serum Mg levels. Our meta-analysis with three studies shows that patients with OSA had significantly lower serum Mg with an effect size of −1.22 (95% CI: −2.24, −0.21). However, the mean serum Mg level of OSA patients (n = 251) pooled from five studies (1.90 mg/dL, 95% CI: 1.77, 2.04) does not differ significantly from the normal range between 1.82 to 2.30 mg/dL. OSA severity appears to affect serum Mg negatively. Serum Mg levels generally improve after treatment, coinciding with the improvement of OSA severity. Low serum Mg levels correlate with the worsening of cardiovascular risk biomarkers of C-reactive protein, ischaemia-modified albumin, and carotid intima-media thickness. The serum Mg levels also potentially correlate with biomarkers for lipid profile, glucose metabolism, calcium, and heavy metals. Conclusions: Sleep deprivation appears to deplete Mg levels of OSA patients, making them at risk of Mg deficiency, which potentially increases systemic inflammation and the risk of cardiovascular and metabolic diseases.

There is limited information regarding the nutrition profile and diet quality of meal plans from currently popular weight loss diets in Australia. This includes the energy content (kilojoules), the macronutrient distribution, and the micronutrient composition. Further, these diets have not been compared with current government guidelines and healthy eating principles for nutritional adequacy. Popular diets were identified through grey literature, trending searches and relative popularity in Australia. Meal plans for each diet were analysed using Foodworks Dietary Software to determine food group intake, micronutrient, and macronutrient distribution. Results indicated that all popular diets assessed deviated from government recommended healthy eating principles such as the Australian Guide to Healthy Eating and the Mediterranean Diet. In most cases both popular diets, and the healthy eating principles had low intakes of multiple food groups, low intakes of essential micronutrients, and a distorted macronutrient distribution. Popular diets may not provide adequate nutrition to meet needs, particularly in the long-term and potentially resulting in micronutrient deficiency. When energy restricting for weight loss, meal plans should be highly individualized in conjunction with a qualified nutrition professional to ensure adequate dietary intake. Refereed/Peer-reviewed

Rational feeding is one of the most important conditions that ensure adequate maturation of various organs and tissues, optimal parameters of physical, psychomotor, intellectual development, infant resistance to infections and other unfavorable external factors. The ideal food for an infant is mother’s breast milk, because it has a relationship with the tissues of the child and is the ‘gold standard’ for optimal nutrition. The nature of feeding in the first year of life largely determines the state of health of the child, not only in infancy, but also in the subsequent years of his life. Insufficient or improper nutrition of the mother during pregnancy and lactation is a consequence of the production of milk with a low content of vitamins and essential nutrients, which may be one of the reasons for the development of alimentary‑dependent conditions in young children, negatively affect growth indicators, nervous and mental development of a child. The best way to replenish the micronutrient deficiency in the diet of nursing mothers is to take biologically active food supplements in the form of vitamin and mineral complexes.

Improving the nutritional content of graminaceous crops is imperative to ensure nutritional security, wherein omics approaches play pivotal roles in dissecting this complex trait and contributing to trait improvement. Micronutrients regulate the metabolic processes to ensure the normal functioning of the biological system in all living organisms. Micronutrient deficiency, thereby, can be detrimental that can result in serious health issues. Grains of graminaceous crops serve as an important source of micronutrients to the human population; however, the rise in hidden hunger and malnutrition indicates an insufficiency in meeting the nutritional requirements. Improving the elemental composition and nutritional value of the graminaceous crops using conventional and biotechnological approaches is imperative to address this issue. Identifying the genetic determinants underlying the micronutrient biosynthesis and accumulation is the first step toward achieving this goal. Genetic and genomic dissection of this complex trait has been accomplished in major cereals, and several genes, alleles, and QTLs underlying grain micronutrient content were identified and characterized. However, no comprehensive study has been reported on minor cereals such as small millets, which are rich in micronutrients and other bioactive compounds. A comparative narrative on the reports available in major and minor Graminaceae species will illustrate the knowledge gained from studying the micronutrient traits in major cereals and provides a roadmap for dissecting this trait in other minor species, including millets. In this context, this review explains the progress made in studying micronutrient traits in major cereals and millets using omics approaches. Moreover, it provides insights into deploying integrated omics approaches and strategies for genetic improvement in micronutrient traits in graminaceous crops.

Iron deficiency is the most common micronutrient deficiency worldwide. Prevention and treatment of iron deficiency conditions are some of the most important health problems in many countries of the world. At the same time, the main problems for it remain the timely diagnosis, elimination of the cause, as well as the choice of replacement therapy with iron-containing drugs and correction of adverse reactions (ADR) that occur during their use.The aim. This research aims to study the peculiarities of the development of antianaemic drugs ADRs in patients living in the territory of the Republic of Crimea.Materials and methods. The objects of research were cases of ADR occurrence associated with the use of a group of antianaemic drugs and revealed during the 2009-2018 period in the territory of the Republic of Crimea. The main tasks in the analysis of notification forms were the study of the ADR severity, the causality assessment for suspected drugs and ADRs, as well as analysis of particular problems associated with the use of antianaemic drugs (Drug-related problems, DRP).Results. Iron supplements in combination with other drugs became the leaders in the incidence of ADR among antianaemic drugs (28 cases, 42.4% of all cases of ADR). The largest number of cases was registered in patients aged from 18 to 30 years, with female patients prevailing. Among the clinical manifestations of ADR, the most cases were drug hypersensitivity reactions of varying severity (40 cases) and disorders of the gastrointestinal tract (18 cases). The study of the problems associated with the use of antianaemic drugs made it possible to determine that the highest rates of DRP values were observed with the use of iron preparations for parenteral use and cyanocobalamine. The minimal DRP values were observed when prescribing iron protein succinylate preparations.Conclusion. The basis of pharmacotherapy for various types of anemias is the replenishment of iron and vitamin B12 (cyanocobalamin) depots. The effectiveness of the treatment in these cases largely depends on the patient's adherence to treatment, which is, in turn, depends on the frequency and severity of ADRs that occur during the use of antianaemic drugs.

Despite improvements in food production and healthcare services, the burden of malnutrition in Uganda has for the last 30yearsremained unacceptably high with rates of stunting (chronic undernutrition) and anemia (proxy for micronutrient deficiency) currently estimated at 29% and 53%,respectively among young children aged 6-59 months. Considering that both undernutrition and over nutrition are greatly attributed to monotonous diets characterized by limited dietary diversity and overdependence on starchy refined grains or roots as staples,there is need to improve the population’s awareness of appropriate dietary practices. To improve nutrition education, the Infant and Young Child-feeding national counseling cards for community volunteers (IYCF cards)that were developed by United Nations Children’s Fund (UNICEF), are currently the standard package used in Uganda’s health sector to educate caregivers on appropriate child-feeding practices. In this study, the effectiveness of a three-group food guide was evaluated against IYCF cards.A randomized, controlled intervention trial engaged three randomly selected distant groups of child-caregiver pairs (n=40) concurrently in one of three treatments namely: (i) nutrition education using a three-foodgroup guide (FG), (ii) nutrition education using age-appropriate IYCF cards, and (iii) negative control group that engaged in hair-plaiting sessions. At baseline, all groups had randomly selected caregivers of children aged 6-14 months and were met once a week for five consecutive weeks during the intervention. Caregivers were interviewed at baseline and 2 months after the interventions to determine changes in child-feeding practices while their children were concurrently measured to determine changes in their nutritional status.At baseline, caregivers in the three treatment arms exhibited inappropriate child-feeding practices indicated by low child-feeding index (CFI) scores,which were also related to poor nutritional status of their children. After the interventions, children in FG group were given more varied animal-source foods than those in IYCF cards group (p =0.02). Compared to controls, caregivers in FG group gave their children significantly more snacks (p = 0.01), their child-feeding practices indicated by CFI scores significantly improved (p = 0.001) and their children exhibited better growth patterns indicated by weight-for-age (p = 0.02) and MUAC-for-age (p = 0.03) Z-scores.These findings,therefore,indicate that the three-group food guide is more likely to improve child-feeding practices and growth patterns than IYCF cards.Hence, there is need to integrate the food guide into IYCF materials to foster child-feeding practices and growth.

One of the most common conditions resulting from micronutrient deficiency is iodine deficiency. Purpose — to evaluate the current state of iodine supply in schoolchildren living in the North-Eastern region of Ukraine, including children with digestive diseases and inflammatory joint diseases. Materials and methods. Target group: 86 people (11.8±2.71 years), which included patients with digestive diseases (DD) (26.7%) and juvenile idiopathic arthritis (JIA) (60.5%). Methods: dietary iodine intake evaluation by urinary iodine concentration (Sandell–Kolthoff reaction), followed by calculation of the median. Results. Median urinary iodine excretion was at the lower normal range and amounted to 104.98 μg/l [QR: 59.8; 180.1] in the examined children. Only 51.2% of children had adequate iodine provision; mild iodine deficiency (ID) was diagnosed in 29.1% (Ме=81,91μg/l [QR: 64.26; 90.58]); moderate — 17.4% (Ме=36,19 μg/l [QR: 33.54; 42.24]); severe — in 2.3% of the surveyed (Ме 14,02 μg/l [QR: 12.34; 15.70]). The median urinary iodine excretion in children with somatic diseases was significantly lower than in children of the control group and amounted to 97.26 μg/l [QR 53.7; 148.3] versus 183.71 μg/l [QR 104.4; 287.4], (p=0.003). Conclusions. School-age children have a high incidence of iodine deficiency (51.2%). Often encountered in childhood diseases (DD and JIA) are accompanied by insufficiency of iodine supply. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: iodine deficiency, school-age children, the level of iodine excretion.

Micronutrient deficiency persists throughout the world, and although the burden is higher in low-resource settings, it is also prevalent in wealthy countries, a phenomenon termed ‘hidden hunger’. Due to their high requirements for vitamins and minerals relative to their energy intake, young women and children are particularly vulnerable to hidden hunger. As they share several risk factors and impact on overlapping outcomes, we consider how deficiency of iron, iodine and vitamin D can have profound impacts on perinatal health and infant development. We review the epidemiology of these micronutrient deficiencies during pregnancy, including social, environmental and dietary risk factors. We identify the main challenges in defining nutritional status of these nutrients using validated diagnostic criteria linked with meaningful clinical outcomes. Public health strategies are urgently required to improve the overall health and nutritional status of women of reproductive age. Obesity prevention and early detection of malnutrition with standardised screening methods would detect pregnant women at increased risk of iron deficiency. Development of sensitive, individual biomarkers of iodine status is required to protect maternal health and fetal/infant brain development. Risk assessments of vitamin D requirements during pregnancy need to be revisited from the perspective of fetal and neonatal requirements. International consensus on standardised approaches to micronutrient assessment, analysis and reporting as well as sensitive, clinically validated infant and child neuro-behavioural outcomes will enable progression of useful observational and intervention studies.

Background Malaria and malnutrition represent major public health concerns worldwide especially in Sub-Sahara Africa. Despite implementation of seasonal malaria chemoprophylaxis (SMC), an intervention aimed at reducing malaria incidence among children aged 3–59 months, the burden of malaria and associated mortality among children below age 5 years remains high in Burkina Faso. Malnutrition, in particular micronutrient deficiency, appears to be one of the potential factors that can negatively affect the effectiveness of SMC. Treating micronutrient deficiencies is known to reduce the incidence of malaria in highly prevalent malaria zone such as rural settings. Therefore, we hypothesized that a combined strategy of SMC together with a daily oral nutrients supplement will enhance the immune response and decrease the incidence of malaria and malnutrition among children under SMC coverage. Methods Children (6–59 months) under SMC coverage receiving vitamin A supplementation will be randomly assigned to one of the three study arms (a) SMC + vitamin A alone, (b) SMC + vitamin A + zinc, or (c) SMC + vitamin A + Plumpy’Doz™ using 1:1:1 allocation ratio. After each SMC monthly distribution, children will be visited at home to confirm drug administration and followed-up for 1 year. Anthropometric indicators will be recorded at each visit and blood samples will be collected for microscopy slides, haemoglobin measurement, and spotted onto filter paper for further PCR analyses. The primary outcome measure is the incidence of malaria in each arm. Secondary outcome measures will include mid-upper arm circumference and weight gain from baseline measurements, coverage and compliance to SMC, occurrence of adverse events (AEs), and prevalence of molecular markers of antimalarial resistance comprising Pfcrt, Pfmdr1, Pfdhfr, and Pfdhps. Discussion This study will demonstrate an integrated strategy of malaria and malnutrition programmes in order to mutualize resources for best impact. By relying on existing strategies, the policy implementation of this joint intervention will be scalable at country and regional levels. Trial registration ClinicalTrials.gov NCT04238845. Registered on 23 January 2020 https://clinicaltrials.gov/ct2/show/NCT04238845

Aim: Increased frequency of deficiency due to the insufficient intake of iron, zinc, vitamin B12-D and folic acid has been reported in the society. We aimed to investigate the rates of deficiency of these vitamins and minerals, as well as anemia frequency in children admitted to pediatric outpatient clinics of our tertiary hospital in a retrospective three-year period. Materials and Methods: The frequency of micronutrient deficiency and the relationship between them was determined using statistical methods by evaluating the levels of hematocrit and other micronutritional elements in patients admitted to the general pediatrics outpatient clinics of our hospital between 01.06.2015 and 31.05.2018. The only patient inclusion criteria were being tested for zinc, iron, iron binding, hemogram, vitamin B12, folic acid, ferritin and vitamin D for any reason. Results: After the evaluation of 64487 patients, we discovered the rates of anemia and iron, zinc, folate, vitamin D, vitamin B12 and ferritin deficiency as 30.8%, 52.1%, 41.1%, 18.2%, 32.4%, 20.1% and%26.7 respectively. Additionally, our results indicate that the frequency of folic acid deficiency decreased over the past years, whereas the rates of zinc and vitamin D deficiency increased over time. The final results show a negative correlation between anemia and folic acid, vitamin D, vitamin B12 and iron binding capacity, and a positive correlation between anemia and iron, ferritin and zinc. Conclusion: Although it does not reflect the frequency of deficiency in the general population since the data are collected from hospitalized children, it could be argued that multiple micronutrient deficiencies are significantly common in Turkey and zinc and vitamin D deficiency has been increasing over the years, when compared with the results of previous studies.

Dysphagia is an underlying symptom of many health issues affecting a person's ability to swallow. Being unable to swallow correctly may limit food intake and subsequently micronutrient status. The elderly may be the most at risk group of suffering dysphagia as well as most likely to be deficient in micronutrients. The use of texture-modified meals is a common approach to increasing dysphagia sufferer's food intake. The modification of food may affect the micronutrient content and currently there is a limited number of studies focusing on micronutrient content of texture-modified meals. This review considers the prevalence of dysphagia within the elderly UK community whilst assessing selected micronutrients. Vitamin B12, C, D, folate, zinc and iron, which are suggested to be most likely deficient in the general elderly UK population, were reviewed. Each micronutrient is considered in terms of prevalence of deficiency, metabolic function, food source and processing stability to provide an overview with respect to elderly dysphagia sufferers.

Due to the spread of the western style diet, which is characterized by high intake of processed food, micronutrients (vitamins and minerals) deficiency is increasing in the Japanese population of all ages and genders. During pregnancy, the elevated demand for micronutrients put pregnant women at even higher risk of micronutrients deficiency. Some micronutrients are relatively famous such that women with reproductive age are recommended to take folic acid supplementation for the prevention of neural tube defect. However, it is not generally known that folate is also important for fetal growth throughout the pregnancy course and for prevention of pregnancy complications, and that pregnant women should continue to take supplementation during pregnancy and lactation. The types of micronutrients and the duration of supplementation are both important factors to maintain normal pregnancies. This review focused on four micronutrients that are commonly deficient in Japanese pregnant women, folate, vitamin B12, vitamin D, calcium, and magnesium. The detrimental effects of homocysteine accumulation associated with the above micronutrient defects and its link to catechol-o-methyltransferase insufficiency are described. We also discussed possible molecular mechanisms of pregnancy complications and the development origin of health and disease (DOHaD) regarding micronutrient deficiencies from the point of view of one carbon metabolism.

The goal of this article is to review micronutrient deficiencies in patients with obesity. We will describe the absorption of micronutrients and highlight the risk factors that may exist pre- and post-surgery that contribute to the development of micronutrient deficiency states. Furthermore, we will discuss the process involved in detecting, preventing, and treating micronutrient deficiencies. Pre-bariatric surgery micronutrient deficiencies are commonly due to intake of a high energy, but low micronutrient diet. Deficiencies frequently include vitamin D, folate, vitamin B12, and iron. Post-bariatric surgery micronutrient deficiencies are commonly related to altered absorption in the setting of non-compliance with or intolerance of recommended diets, and frequently include abovementioned deficiencies as well as vitamin A, copper, and zinc deficiencies. All patients should have routine daily supplementation as well as close monitoring for the development of deficiency post-surgery. It is important to understand a patient’s unique risk factors for developing a micronutrient deficiency, and to perform a complete nutritional evaluation to further assess, intervene on, and monitor a patient’s nutritional status throughout their pre- and post-operative course. Treatment of these deficiencies will require a multidisciplinary and multimodal approach involving risk factor modification and supplementation that depends on the severity and duration of the identified deficiency.

Purpose of review Ready-to-use therapeutic foods (RUTF) allow effective community-based management of severe acute malnutrition (SAM). Current interest focuses on their optimal composition and use. Recent findings Studies of alternative RUTF have yielded differing results. Partial soybean, sorghum flour, and whey protein replacement RUTF were inferior to standard RUTF. In contrast, soy-based RUTF was as effective as milk-based RUTF and an alternative RUTF with added oats lead to superior recovery in comparison to standard RUTF.Reducing the dose of RUTF in the later phases of SAM recovery resulted in small reductions in the growth of uncertain clinical significance.Although iron and vitamin A status improve during treatment with standard RUTF, a significant proportion of children remained deficient. Alternative soya, maize, and sorghum-based formulas with no milk protein may improve recovery of iron status compared to standard RUTF.Finally, in children with SAM, plasma essential fatty acids and conversion to long-chain polyunsaturated fatty acids are reduced. Despite the improvement, these parameters remain lower than in normal children after 3 months. Summary New RUTF formulations may provide a cost-effective alternative to standard RUTF. Future research should focus on addressing micronutrient deficiency, lipid metabolism, and long-term recovery.

Sometimes referred to as hidden hunger, micronutrient deficiencies persist on a global scale. For some micronutrients this appears to be due to inadequate intake, for others intake may not match increased requirements. However, for most micronutrient deficiencies there is uncertainty as to the dominant driver, and the question about the contribution of malabsorption is open. Environmental enteropathy (EE), formerly referred to as tropical enteropathy and also referred to as environmental enteric dysfunction, is an asymptomatic disorder of small intestinal structure and function which is very highly prevalent in many disadvantaged populations. Recent studies of the pathology and microbiology of this disorder suggest that it is driven by very high pathogen burdens in children and adults living in insanitary environments and is characterised by major derangements of the epithelial cells of the intestinal mucosa. Transcriptomic data suggest that it may lead to impaired digestion and absorption of macronutrients. Given the very high prevalence of EE, marginal malabsorption could have large impacts at population scales. However, the relative contributions of inadequate soil and crop micronutrient contents, inadequate intake, malabsorption and increased requirements are unknown. Malabsorption may compromise attempts to improve micronutrient status, but with the exception of zinc there is currently little evidence to confirm that malabsorption contributes to micronutrient deficiency. Much further research is required to understand the role of malabsorption in hidden hunger, especially in very disadvantaged populations where these deficiencies are most prevalent.

With the increasing global prevalence of inflammatory bowel diseases, research in this field is expanding to better understand the multifactorial etiologies of this complex disease. Nutrition and diet, as modifiable risk factors, have been shown to play an important role in disease activity and prognosis. This article reviews the role of nutrition in inflammatory bowel disease, including appropriate nutrition screening in this at-risk population, and associated micronutrient deficiencies. We provide recommendations on dosing supplementation. We briefly review diet as a risk factor for inflammatory bowel disease and the currently proposed published dietary intervention studies.

Purpose of review Iron deficiency is the most common micronutrient deficiency and infants are at particular risk. The purpose of this review is to summarize recent studies that explored the metabolism of iron in infants as well as the risks and benefits of iron supplementation in different populations. Recent findings The ability of infants to regulate iron homeostasis is not fully known but most likely different from adults. Reducing iron deficiency has beneficial effects on neurodevelopment but iron overload may have adverse functional effects including diarrhea and even poor neurodevelopment. Recent studies have confirmed benefits of delayed cord clamping and supplementation of infants in risk groups while iron supplementation to pregnant women has shown limited effect in the offspring with regard to iron status and neurodevelopment. Further support is given to the recommendation that exclusive breast feeding, without supplementation, is safe for normal birth weight infants until 6 months whereafter an iron-rich diet should be given. Summary Iron deficiency negatively impacts global health but efforts to identify optimal interventions are progressing. Yet, questions remain, particularly regarding long-term risks, benefits and optimal interventions for low birth weight infants as well as the level of iron fortification in infant formula.

Background Children with cleft lip and/or palate can be undernourished due to feeding difficulties after birth. A vicious cycle ensues where malnutrition and low body weight precludes the child from having the corrective surgery, in the absence of which the child fails to gain weight. This study aimed to identify the proportion of malnutrition, including the deficiency of major micronutrients, namely iron, folate and vitamin B12, in children with cleft lip and/or palate and thus help in finding out what nutritional interventions can improve the scenario for these children. Methods All children less than 5 years with cleft lip and/or cleft palate attending our institute were included. On their first visit, following were recorded: demographic data, assessment of malnutrition, investigations: complete blood count and peripheral blood film examination; serum albumin, ferritin, iron, folate, and vitamin B12 levels. Results Eighty-one children with cleft lip and/or palate were included. Mean age was 25.37± 21.49 months (range, 3–60 months). In 53% of children suffered from moderate to severe wasting, according to World Health Organization (WHO) classification. Iron deficiency state was found in 91.6% of children. In 35.80% of children had vitamin B12 deficiency and 23.45% had folate deficiency. No correlation was found between iron deficiency and the type of deformity. Conclusion Iron deficiency state is almost universally present in children with cleft lip and palate. Thus, iron and folic acid supplementation should be given at first contact to improve iron reserve and hematological parameters for optimum and safe surgery.